MENISCUS / CARTILAGE TEAR

The meniscus is a commonly injured structure in the knee. The injury can occur in any age

group. In younger people, the meniscus is fairly tough and rubbery, and tears usually occur as a

result of a forceful twisting injury. The meniscus grows weaker with age, and meniscal tears can

occur in aging adults as the result of fairly minor injuries, even from the up-and-down motion of

squatting.

What is a meniscus, and what does it do?

There are two menisci between the shinbone (tibia) and thighbone (femur) in the knee joint. The

C-shaped medial meniscus is on the inside part of the knee, closest to your other knee. The U-

shaped lateral meniscus is on the outer half of the knee joint.

These two menisci act like shock absorbers in the knee. Forming a gasket between the shinbone

and the thighbone, they help spread out the forces that are transmitted across the joint. Walking

puts up to 2 x your body weight on the joint. Running puts about 8 x your body weight on the

knee. As the knee bends, the back part of the menisci takes most of the pressure.

Articular cartilage is a smooth, slippery material that covers the ends of the bones that make up

the knee joint. The articular cartilage allows the surfaces to slide against one another without

damage to either surface.

By spreading out the forces on the knee joint, the menisci protect the articular cartilage from

getting too much pressure on one small area on the surface of the joint. Without the menisci, the

forces on the knee joint are concentrated onto a small area, leading to damage and degeneration

of the articular cartilage, a condition called osteoarthritis.

How do meniscal problems develop?

In younger people, the meniscus is a fairly tough and rubbery structure. Tears in the

meniscus in patients under 30 years old usually occur as a result of a fairly forceful twisting

injury. The entire inner rim of the medial meniscus can be torn in what is called a bucket handle

tear. The meniscus can also have a flap torn from the inner rim.

The tissue that forms the menisci weakens with age, making the menisci prone to degeneration

and tearing. People of older ages often end up with a tear as result of a minor injury, such as

from the up-and-down motion of squatting. Most often, there isn't one specific injury to the knee

that leads to the degenerative type of meniscal tear. These tears of the menisci are commonly

seen as a part of the overall condition of osteoarthritis of the knee in aging adults. Degenerative

tears cause the menisci to fray and become torn in many directions.

Symptoms

The most common problem caused by a torn meniscus is pain. The pain may be felt along the

edge of the knee joint closest to where the meniscus is located. Or the pain may be more vague

and involve the whole knee.

The knee may swell, causing it to feel stiff and tight. This is usually because fluid accumulates

inside the knee joint. This is sometimes called water on the knee. This is not unique to meniscal

tears, since it can also occur when the knee becomes inflamed.

The knee joint can also lock up if the tear is large enough. Locking refers to the inability to

completely straighten out the knee. This can happen when a fragment of the meniscus tears free

and gets caught in the hinge mechanism of the knee, like a pencil stuck in the hinge of a door.

Diagnosis

Diagnosis begins with a history and physical exam. X-rays will not show the torn meniscus. X-

rays are mainly useful to determine if other injuries are present.

Magnetic resonance imaging (MRI) is very good at showing the meniscus. If there is

uncertainty in the diagnosis following the history and physical examination, or if

other injuries in addition to the meniscal tear are suspected, the MRI scan may be suggested.

If the history and physical examination indicate a torn meniscus, arthroscopy may be suggested to

confirm the diagnosis and treat the problem at the same time. Arthroscopy is an operation that

involves inserting a miniature fiber-optic TV camera into the knee joint, allowing the orthopedic

surgeon to look at the structures inside the joint directly. The arthroscope lets the surgeon see

the condition of the articular cartilage, the ligaments, and the menisci.

Treatment

Nonsurgical Rehabilitation

Whether you are going to have surgery or manage your knee conservatively the initial treatment

for a torn meniscus focuses on decreasing pain and swelling in the knee. Rest and anti-

inflammatory medications can help decrease these symptoms. Your Physiotherapist will also

advise on the use of ice and rest periods with your leg supported in elevation to treat swelling

and pain. Nonsurgical rehabilitation for a meniscal injury typically lasts 6-8 weeks. Once your

physiotherapist is happy that pain and swelling are controlled they can guide you on exercises to

improve knee range of motion and strength are added gradually You can return to your sporting

activities when your quadriceps and hamstring muscles are back to nearly their full strength and

control.

Surgery

Surgery may be recommended as soon as reasonably possible to remove the torn part that is

getting caught in the knee joint. But even a less severely torn meniscus may not heal on its own.

If symptoms continue after nonsurgical rehabilitation, surgery will probably be suggested to either

remove or repair the torn portion of the meniscus. Surgeons use an arthroscopic camera which is

inserted into the knee via 2-3 small incisions and remove damaged meniscus.

Post-operative Rehabilitation

After surgery Physiotherapy can assist in regaining full strength and return to activities. Please see below.

INITIAL POST-OPERATIVE REHABILITATION

□ HEEL SLIDES

Placing heel on a smooth surface i.e. laminate flooring slide heel to buttocks till you reach a tight end point. Push just past this then slide your heel down till the knee is straight then contract your thigh muscles to achieve further extension.

□ ISOMETRIC QUADS

□ TERMINAL EXTENSION AGAINST GREY BAND

□ STRAIGHT LEG RAISE

REPETITIONS:

SETS:

Place a rolled up towel under your knee. Tighten your thigh muscles to push down against the towel aiming to get your knee really straight.

LENGTH OF HOLD:

REPETITIONS:

SETS:

Place band around back of knee as shown in picture. Keeping heel on the floor allow knee to bend then by contacting your thigh muscles squeeze back against band. Ensure the movement just comes from your knee not from your body. The work should be felt along your thigh.

REPETITIONS: SETS:

Tighten the quadriceps muscles of your straight leg and lift the leg 12 in. (32 cm) to 18 in. (46 cm) off the floor, hold it for 5 seconds, then slowly lower the leg back down and rest a few seconds

REPETITIONS: SETS:

□ SINGLE LEG CO CONTRACTION

□ WALL SIT

□ BALL SQUAT

□ SINGLE LEG STEP UP

Keeping core on push heel into floor and without actually moving your leg push down and back into the floor to activate the correct muscles.

REPETITIONS:LENGTH OF HOLD:SETS:

This is an isometric strengthening exercise for the quadriceps. Bend knees to a comfortable level placing back flat against wall. Progress by increasing depth of the squat. Tension should be felt in quadriceps and not in the knee cap.

LENGTH OF HOLD:

REPETITIONS:

Ball in small of back against the wall. Feet shoulder width apart. Squat to a comfortable level. Push up through heels keeping quads tight.

REPETITIONS: SETS:

Place your foot on the step. Engage your core and drive up through your front heel to step up onto the box. Do not push off your back leg. Try to keep your hip-knee-ankle in line and not to sway your trunk to the side as you drive up onto the step.

REPETITONS:

SETS:

□ SINGLE LEG BALANCE

□ STRAIGHT LEG PRESS

□ SINGLE LEG SQUAT

Practice standing on your affected leg to improve your balance. Small receptors in the joints called proprioceptors are affected during your injury and operation. Also focus on keeping your bottom muscles tight to support yourself.

As you get better the exercise can be improved by standing on an unstable surface i.e. wobble board, bosu ball and by closing your eyes. Also you can challenge yourself by getting someone to through a ball at you whilst you hold your position.

REPETITIONS:

SETS:

WEIGHT

This is a more advanced exercise and will only be introduced when you have good control and suitable strength. As shown in picture stand on injured leg. Keep bottom muscles strong. Core on and pelvis should stay level. Hold this stable position as you introduce a controlled squat on the 1 leg. Your back should stay straight. Squat as low as you have control and stay out of pain

REPETITIONS:

SETS: